Sudden cardiac arrest as a presenting symptom of mitral valve prolapse.

Mitral valve prolapse (MVP) is a common and predominantly benign condition; however, occasional reports of cardiac arrest in individuals with MVP have raised concern for a malignant subtype. The risk of sudden cardiac arrest in MVP is twice as high as that in the general population. The exact aetiology and risk predictors are elusive, but identification is necessary, if we are to protect patients at risk for cardiac arrest. This report highlights cardiac arrest as the initial presenting symptom of MVP. Rapid initiation of bystander cardiopulmonary resuscitation and time to first shock are key predictors of prognosis. Better screening to identify individuals with malignant phenotypes may aid in reducing the morbidity and mortality in patients with a predisposition for life-threatening arrhythmias.

Estimating Length of Stay for Simple Gastroschisis.

BACKGROUND: Length of stay (LOS) is an important measure of quality; however, estimating LOS for rare populations such as gastroschisis is problematic. Our objective was to identify explanatory variables for LOS and build a model to estimate LOS in neonates with simple gastroschisis. METHODS: In 73 neonates with simple gastroschisis (47% female, 67% White), statistical correlations for 31 potential explanatory variables for LOS were evaluated using multivariate linear regression. Poisson regression was used to estimate LOS in predetermined subpopulations, and a life table model was developed to estimate LOS for simple gastroschisis. RESULTS: Female sex (-2.4 d), "time to silo placement" (0.9 d), total parenteral nutrition days (0.6 d), need for any nasogastric feedings (11.4 d) and at discharge (-7 d), "feeding tolerance" (0.4 d), days to first postoperative stool (-0.3 d), and human milk exposure (-3.4 d) associated with LOS in simple gastroschisis. Estimated LOS for preterm neonates was longer than term infants (5.4 versus 4.6 wk) but similar for estimates based on sex and race. Based on these associations, we estimate that >50% of neonates with simple gastroschisis will be discharged by hospital day 35. CONCLUSIONS: We identified several associations that explained variations in LOS and developed a novel model to estimate LOS in simple gastroschisis, which may be applied to other rare populations.